Practical observations on diphtheria and erysipelas / by Charles Bell.

  • Bell, Charles, Sir, 1774-1842.
Date:
1864
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Licence: Public Domain Mark

Credit: Practical observations on diphtheria and erysipelas / by Charles Bell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    reports, which, according to Dr. Green,* record only one case in which a cure was effected by medical treatment; all his other cases proving fatal between eighteen and thirty-six hours after the voice indicated that the larynx was affected by membranous exudations. The erroneous opinion which is entertained by the French physicians is opposed by all our best authors. Dr. Aberci'ombie considered diphtheria as an affection quite distinct from idiopathic inflammation of the membrane of the larynx and trachea to which we commonly apply the name of croup, which is a pure active inflamma- tion, in which by early and decided treatment we have the fairest prospect of being able to arrest its progress. f In reference to this subject Dr. Tweedie, J in his excellent article on the diseases of the throat, states that in true tracheitis or croup there is inflammation of the mucous membrane, followed by exudation of false membrane, but the disease is limited to the trachea, and does not extend to the throat; while in pellicular pharyngitis (angina membraneuse, or diphtheria) the inflammation commences in the pharynx, and that the constitutional symptoms and treatment of the two diseases are essentially dissimilar. In croup the local symptoms denote inflammation of the trachea, and the symptomatic fever is inflammatory, requiring vigorous anti- phlogistic treatment, whereas in diphtheria, though the accom- panying symptoms denote acute disease, yet in many cases, and even during an epidemic, the tendency of the local in- flammation is to assume a gangrenous character; the type of the accompanying fever is typhoid. The only similarity between the two diseases is that in both there is the forma- tion of a false membrane in the pharynx, and in some instances extending to the trachea; and in the other origi- nating in, and in its progress being confined to, the trachea. If this is a correct statement, it is of great practical import- ance, particularly if we bear in mind, along with the history and symptoms of the disease, the admirable diagnosis of croup given by Dr. Cheyne, who is one of our highest authorities on that subject. He has clearly established that croup is limited in its attack to the period of life between the second month and puberty; and that it generally comes on suddenly, after the patient has gone to bed; when his sleep is disturbed by a harsh, ringing cough, as if the sound passed * 'Treatise on Diseases of the Air-passages.' By Horace Green, M.D., p. 240. t Op. cit., p. 52. X 'Cyclopaedia of Practical Medicine,' vol. iv, p. 179. 2